Pap smear versus speculum examination: can we teach providers to educate patients?

OBJECTIVE To test whether provider-based training in focused patient communication can improve patient knowledge about Pap screening as part of the speculum examination in an urban urgent care setting. METHODS A separate samples pretest, posttest study evaluated the intervention. Before the intervention, we surveyed a convenience sample of 383 consecutive patients who received a speculum examination in a gynecology urgent care clinic of an urban public hospital about their understanding of the Pap smear and its correct use. The intervention trained healthcare providers to briefly explain speculum examinations and Pap smears. After the intervention, we surveyed 130 additional consecutive patients. RESULTS The intervention was associated with improved identification that a Pap smear had not been performed (57.7% preintervention vs. 70.7% postintervention, p = 0.013) and improved knowledge that the Pap smear screens only for cervical cancer (12.0% preintervention vs. 23.8% postintervention, p = 0.002). In logistic regression analysis controlling for age and other potential confounders, being in the postintervention group and speaking Spanish predicted correct identification of Pap test use (odds ratio [OR], 95% confidence interval [CI] 2.70, 1.54-4.75, and 2.98, 1.48-5.98, respectively). CONCLUSIONS In an urban urgent care setting, patients may lack awareness that screening tests are not being performed at the time of a problem-oriented pelvic examination. A targeted intervention to improve physician counseling was associated with partial improvement in patient awareness and knowledge.